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PubMed1984

Pathological parameters useful in predicting prognosis for patients with breast cancer.

The pathologist has critically important responsibilities as a consultant in the management of patients with breast cancer. The clinical evaluation of the anatomic extent of cancer before treatment, the clinical-diagnostic stage, crudely estimates whether the cancer is localized to the breast, or whether there are regional or distant metastases. The pathologist establishes the diagnosis of cancer microscopically in a biopsy and reports the significant characteristics which can be used in the selection of therapy. The pathologist's additional gross and microscopic examinations after mastectomy, which more precisely document the anatomic extent of the cancer, are the basis of the postsurgical treatment-pathologic stage and provide additional information used to estimate prognosis and determine whether adjunctive therapy is needed. The pathology information used in staging includes the tumor size, histologic type, histologic grade, and presence or absence of axillary of other metastases. These and other pathological factors of significance which are discussed include the gross contour of the tumor as well as the presence or absence of necrosis, and any of the spectrum of cancers that we categorize as "minimal breast cancer" (in situ lobular carcinoma, intraductal carcinoma, invasive carcinoma smaller than 0.5 cm). Furthermore, the prognostic implications of the various histologic types are considered, as well as histologic and cytologic differentiation (grade), multicentricity, vascular invasion, cellular infiltration, and various other factors such as mucin or lipid production, steroid hormone receptors, and the nature of the tumor bed. The presence or absence of axillary lymph node metastases remains the single most significant variable in estimating prognosis for most breast cancers. In addition, combinations of the parameters noted above may have greater prognostic significance than any considered individually. Therefore, the pathologist, through the routine examination and documentation of breast biopsies and mastectomies, can provide important information which can be used to aid in the selection of treatment and in the estimation of prognosis.

Breast↗

PubMed1984

Cardiac tumors. Clinical spectrum and prognosis of lesions other than classical benign myxoma in 20 patients.

Between 1961 and 1983, 20 patients underwent operation at the Texas Heart Institute for primary tumors other than classical benign myxoma. Total follow-up was 70.7 patient years (mean 3.5 years). There were 10 adults and 10 children under 12 years of age. There were two operative deaths and four late deaths. All of the pediatric patients had benign lesions (five fibromas, five rhabdomyomas), and only one patient in this group died (during the operation). All operative survivors are alive between 0.9 and 18 years postoperatively, although in three cases excision was incomplete. Of the 10 adult patients, five had benign lesions; all were completely excised. In the other five adult patients, unresectable malignant tumors were found, and all four operative survivors died of metastatic disease within 8 months. Benign cardiac tumors in childhood have an excellent prognosis when completely excised and appear to have a good short-term prognosis even when excision is incomplete. Although prognosis for benign tumors in adults is good, malignant tumors are associated with very poor survival.

Adolescent↗

PubMed1984

Exercise testing in the early period after myocardial infarction in the evaluation of prognosis.

Prognosis for the patient recovery from an acute myocardial infarction is related mainly to electrical instability, left ventricular function, residual ischemia, and extent of coronary atherosclerosis. Many procedures now exist that allow investigation of these various aspects of cardiovascular function and stratification of risk. No ideal marker of prognosis exists because prognosis is not related to a single factor, because the various determinants are often interdependent, and also because they are time dependent. Thus, the presence of ischemia may be particularly important in the first year when the risk is greater, whereas left ventricular function may be the most important factor thereafter. For this reason, an active strategy for detecting ischemia, by exercise testing or other means, may add to clinical observation. Exercise testing is a safe and noninvasive method that can provide information not only on residual ischemia but also on other aspects of cardiovascular function. Many parameters can be studied, such as ST segment elevation or depression, chest pain, ventricular arrhythmias, tolerance to exercise, completion or not of the test, and the heart rate and blood pressure responses. Some of these data are not specific and must be complemented by further investigation. Such as approach should allow an overall evaluation of the cardiovascular function of the patient and an assessment of risk, and help institute an optimal treatment.

Angina Pectoris↗

PubMed1984

[A multivariate prognosis model for Hodgkin disease].

The authors describe the application of the linear discriminatory analysis as a pattern of prognosis for a group of 83 irradiated patients with Hodgkin disease. They investigated which combination of primary characteristics allows the most accurate discrimination between a group of patients with favorable prognosis and a group with unfavorable prognosis. Stage, histology, age, and clinical symptomatology proved to be valuable discriminatory factors. The accuracy of the discriminatory criterium is 75%. The results are compatible with the temporally comparable observations about prognostic factors. The method is suitable for gaining further quantitative knowledge.

Adolescent↗

PubMed1981

[Long-term prognosis of cardiac pulmonary edema].

A retrospective determination of survival time over a total control phase of eight years was done in 53 patients who had been admitted to an internal intensive care unit in 1970 because of cardial pulmonary edema. The hospital survival rate amounted to 55%. 27% of the patients were still alive six months after discharge; after a year there were only 20%. Three of the 53 patients reached the 8th control year. The most unfavorable short- and long-term prognosis by far was evidenced by pulmonary edema resulting from an acute myocardial infarction with a hospital lethality of 80%; none of these patients survived longer than two years (n = 19). Irrespective of the nature of the basic disease, comparable rates were found for those types of pulmonary edema connected with a higher grade insufficiency of the right heart and corresponding increase of the central venous pressure over 20 cm water column (n = 13). In contrast, the pulmonary edema in consequence of a cor hypertonicum had a fairly good prognosis, because the 50% survival rate amounted to four years in this group (n = 21). All attempts to quantify the life prognosis in cases of pulmonary edema possess only speculative significance for the interests of the individual case. Nevertheless, they are indispensable for the correct choice of therapeutic procedure in medical borderline situations.

Aged↗

PubMed1984

Breast carcinoma in elderly women: pathology, prognosis, and survival.

There is a widely held belief that breast carcinoma occurring in elderly women is characterized by a relatively favorable prognosis and unusual histologic types of tumors. To assess these topics in a single patient group, 169 women (greater than or equal to 75 years) treated by mastectomy for primary operable breast carcinoma at Memorial Hospital (1964 to 1970) were identified. Followup revealed that 117 patients (70 percent) died. Thirty-eight women (22 percent) developed recurrent breast carcinoma and 35 (21 percent) were known to have died of the disease. Death was attributable to a cause other than breast carcinoma in 82 cases (49 percent). Remaining alive were 48 patients (28 percent) including 3 with recurrent carcinoma. Four patients (2 percent) were lost to followup. The age-adjusted survival experience of our elderly breast cancer patients was significantly poorer than that of a standard population when compared by the life table method. This difference appeared largely to reflect the mortality effect of breast cancer. Median times to recurrence (25 mo) and to death from breast carcinoma (27 mo) were not prolonged. Pathologic analysis revealed that some tumor types with a relatively favorable prognosis (mucinous, papillary, infiltrating lobular) occur more often in elderly women. However, this probably has little bearing on overall prognosis in the group since infiltrating duct carcinoma which constitutes nearly three-quarters of the tumors was responsible for 86 percent of deaths due to breast carcinoma.

Axilla↗

PubMed1984

[Prognosis and treatment of scleroderma].

The prognosis and treatment of scleroderma depend on the clinicopathological form of the disease: superficial, localised scleroderma is only a minor cosmetic problem; circumscribed, deep forms of scleroderma may cause troublesome symptoms which justify steroid therapy. Circumscribed and diffuse scleroderma are similar to systemic scleroderma for which prognostic criteria have been identified. There is a poor prognosis in men, in extensive skin involvement and in intestinal, cardiac or renal involvement. Limited skin disease and anti-centromere antibodies are associated with a good prognosis. The absence of an animal model and the uncertainty as to the underlying cause, explain the therapeutic problems. The authors discuss the respective value of a number of "specific" drugs, including D-penicillamine which seems to be the most hopeful line of treatment. Continuous follow-up of this chronic condition remains essential for the diagnosis and symptomatic management of visceral complications.

Adrenal Cortex Hormones↗

PubMed1983

[Malignant melanoma of the conjunctiva arising from precancerous melanosis, prognosis and treatment].

A 68-year-old white female with lentigo malignans of the right conjunctiva and lid developed recurrent malignant melanomas of the conjunctiva 16 years after, lesions were treated by local excision and cryotherapy on several occasions. The prognosis of the three different histologic types of malignant melanoma described by Clark: nodular melanoma, superficial spreading melanoma, and lentigo malignans melanoma is discussed. Histologic features associated with the height of the tumor are important factors for prognosis, patients with lentigo malignans melanoma appearing to have a better systemic prognosis than those with superficial spreading or nodular melanoma. Possible therapeutic approaches to this condition are exenteration of the orbit, excision combined with cryotherapy, and excision combined with radiotherapy. The advantages of each of these treatments, and their indications, are discussed.

Aged↗

PubMed1983

Factors associated with prognosis in human breast cancer. II. Multivariate stratification analysis.

Prediction of the individual fate of breast cancer patient is one of the most important problems for establishment of therapeutic plans. We have analyzed the relationships of clinical factors to 3-year and 8-year survivals in a series of 400 patients treated for breast carcinoma. Multivariate stratification analysis for obtaining subgroups with different survivals was performed with the aid of Bintree, a computer program which produces binary splits of a population according to the criterion of maximal reduction of variance, and generates a binary stratification tree. Lymph node status was the major predictor for both short and long term prognosis but had no important role in the survival of patients who relapsed. Antecedent abortions were related to less relapses. Age, previous benign breast diseases, nulliparity and lactation conditioned better prognosis without association with relapse probability, indicating an association with the speed of evolution of the disseminated disease. In general clinical data were insufficient for establishment of good and bad prognosis polar groups of patients, especially in patients in which no clinical lymph node involvement was recorded.

Adult↗

PubMed1984

[Individual prognosis in children with Hodgkin's disease].

Clinical data on 248 cases of pediatric Hodgkin's disease treated at the Institute within 1967-1981 were evaluated. The study was concerned with criteria for establishing individual prognosis. The prognostic value of 11 factors related to the peculiarities of tumor and host was assessed after the method of Neuman-Pearson. Such factors as stage and malignity of tumor, histological pattern, patient's age, the extent of lymph node involvement, size of conglomerates, status of mediastinal lymph nodes, intoxication, anemia and lymphopenia were found to influence long-term prognosis. Correct prognosis was made in 84,7% of the study group and in 84,0% of controls.

Adolescent↗

PubMed1980

[Prognosis of primary non-obstructive cardiomyopathies].

The prognosis of congestive cardiomyopathy was studied in 132 consecutive patients (110 male, 22 female, average age 45 +/- 11 years) in whom a thorough clinical evaluation had excluded a secondary cause. The patients presented with left ventricular failure, a history of systemic embolism, syncope or radiological cardiomegaly. Right (100 p. 100) and left (81 p. 100) heart catheterisation was performed and left ventricular endiastolic volumes (202 +/- 77 ml/m2) and ejection fractions (31 +/- 12 p. 100) calculated from angiography in the 30 degrees right anterior oblique projection. Regional abnormalities of contraction were observed in 32 patients. The average follow up period was 40,4 +/- 23,8 months. At the end of the study 48 patients (37 p. 100) had died and 2 had been lost to follow up. Survival rates were calculated by actuarial methods. Age, sex, the period they had been symptomatic, alcoholic intoxication and the degree of cardiac dilatation were not significant prognostic factors. Patients in Class IV NYHA had the worst prognosis: 63 p. 100 2 year mortality. Atrioventricular conduction defects were observed in 56 patients and were associated with a significantly increased mortality rate (43 p. 100 compared with 23 p. 100, p < 0.001). Atrial fibrillation (32 patients) was a better prognostic factor than the persistence of sinus rhythm; 2 year mortality 11,1 p. 100 compared to 37,6 p. 100 (p < 0.001). Increased left ventricular end diastolic pressures greater than 20 mmHg were related with a mortality of 51,5 p. 100. Also, the patients with a ejection fraction of 30 p. 100 and a 2 year mortality rate of 44 p. 100 compared to 17,5 p. 100 when the ejection fraction was greater than 30 p. 100 (p < 0,001). In conclusion : 1. Regional abnormalities of left ventricular contraction are not rare in primary cardiomyopathy. 2. The prognosis is directly related to the degree of cardiac failure and the extent of left ventricular dysfunction.

Adolescent↗

PubMed1978

Initial urinary catecholamine metabolite concentrations and prognosis in neuroblastoma.

Initial urinary catecholamine metabolite and amino acid excretion patterns were examined in 54 children with neuroblastoma. The relationships between prognosis and age at diagnosis, stage of disease, primary site, and histologic grade of tumor were similar in this population to those found in previous studies, but only age and stage were found to be independent prognostic variables. Prognosis in disseminated disease was found to correlate directly with the urinary vanilmandelic acid (VMA)/homovanillic acid (HVA) ratio but not with the absolute levels of HVA. The presence of the dopa metabolite, vanillactic acid, as well as increased amounts of cystathionine and/or low levels of VMA indicated poor prognosis. These results are consistent with the hypothesis that biochemically primitive neuroblastomas deficient in dopamine beta-hydroxylase are move virulent than their mature analogues which produce epinephrine, norepinephrine, and their metabolites.

Adrenal Gland Neoplasms↗

PubMed1983

[Acute kidney failure: age is not a factor in the prognosis].

The mortality of acute renal failure (ARF) remains distressingly high despite intensive dialysis and remarkable advances in critical care medicine. This lack of survival improvement may be due to an increased frequency of septic ARF and/or the association with multiple organ dysfunction. The role of age, as a factor indicative of a poor prognosis is a matter of controversy. To evaluate this role we have analysed the final outcome of 103 patients with ARF treated between october 1978 and february 1982 by one or more hemodialysis. The average age was 65.1 +/- 14.9 years (mean +/- standard deviation): 64 patients were over 65 years of age (74.7 +/- 10.2), 39 were under this age (47.5 +/- 14.4). Septic causes were found in 64 cases. Sixty eight patients (66%) died during the period of ARF. Mortality was 67% in patients under 65 years of age and 66% in patients over this age (p greater than 0.90). The outcome of septic ARF was independent of age (mortality rate: 79% for patients less than 65 years, 81% for patients greater than 65 years (p greater than 0.90)). The poor prognosis is probably related to multiple organ dysfunction and specially to acute respiratory distress (89% mortality). It can be concluded that patient's age does not worsen the prognosis of ARF.

Acute Kidney Injury↗

PubMed1983

[Effect of the plan of therapy on prognosis in thyroid cancer].

The therapeutic concept used in our Department for the treatment of thyroid cancer is characterized by a facultative external irradiation of the neck region and by a mandatory and intense treatment with radioiodine. The latter includes a complete elimination of remaining normal thyroid tissue and a combined diagnostic add therapeutic radioiodine application in the follow-up of the disease. The therapeutic effect of surgery, hormone substitution, radioiodine treatment and external irradiation combined with the prognosis of thyroid cancer was obvious, but that of individual steps was difficult to separate and quantitate. External irradiation of the neck improved the prognosis of patients with anaplastic carcinoma but no significant effect was observed in patients with follicular carcinoma. Even after prophylactic treatment with high doses of radioiodine the prognosis of differentiated thyroid cancer remained to be highly dependent on biological factors. Radioiodine treatment is recommended in all patients with follicular carcinoma and in patients older than 30 years with papillary carcinoma, but prophylactic treatment should only be performed for a period of 5 years.

Adenocarcinoma↗

PubMed1982

[Factors affecting prognosis of thalamic hemorrhage (author's transl)].

The present study deals with the factors affecting the prognosis in the acute stage of 29 cases with hypertensive thalamic hemorrhage diagnosed by CT scan. It was thought that the following factors were significantly related to the outcome of the patients who were unable to lead daily life, remained in vegetative state or died. (1) Consciousness level was below 10 in the so-called 3-3-9 formula. (2) Bilateral Babinski's signs was observed. (3) Localization of the hematoma was all the thalamic nuclei type. (4) Hematoma volume was above 10 ml. (5) As for the size of hematoma, the maximum dimension of hematoma was over 30 or 35 mm, maximum width over 30 mm, maximum length over 25 mm and maximum height over 30 or 40 mm. (6) Ventricles were dilatated. It was seemed that the prognosis had no significant relationship with the age of the patients, the difference between left and right side of hematoma, with the presence or the absence of ventricular penetration of hematoma, and with the existence of midline shift. We thought that in the acute stage of hypertensive thalamic hemorrhage of the prognosis could be forecasted by neurological findings, accurate calculation of the hematoma volume and size, localization of hematoma and presence or absence of ventricular dilatation by CT scan.

Adult↗

PubMed1982

The left hemiblocks: significance, prognosis and treatment.

This review article is concerned with the concept of left hemiblocks and analyses their significance, prognosis and treatment. It first stresses that the left bundle branch is not sensu stricto a bifascicular structure since it generally is either fanlike, or trifascicular. The anatomical situation, however, remains compatible with the physiological concept of the hemiblocks. The electrocardiographic features of left anterior and posterior hemiblocks are described. A histopathological investigation clearly demonstrates that both are signs of left bundle branch disease, often degenerative in nature and more widely spread than expected from the electrocardiographic terminology. The association of a left hemiblock with right bundle branch block is frequently considered as sign of poor prognosis. This is true in the setting of acute myocardial infarction where it accompanies large infarcts. In chronic cases, the prognosis is primarily influenced by the underlying pathology. Patients with partial bilateral bundle branch block should be investigated and, if needed, paced when they have symptoms, a PR interval which lengthens with the course of time, or signs of cardiomyopathy, or large anterior infarction. Asymptomatic individuals with apparent primary disease of the conducting system are neither studied, nor considered for prophylactic pacing.

Adolescent↗

PubMed1980

[Prognosis of stage II and III breast cancer in women and critique of various aspects of the TNM system].

A five-year survival study has been made on 383 patients with breast cancer belonging to the stages II and III of the TNM classification. After the results we consider advisable making a subdivision of these stages forming groups of patients having a similar prognosis in order to apply a statistical treatment to a more homogeneous group and set the treatment on a prognosis basis. In addition it has been considered convenient to transfer the patients classified as T3N0M0 of stage III to stage II attending to their prognosis. Finally, a TNM classification including said concepts is proposed.

Breast Neoplasms↗

PubMed1978

[Femoral neck fracture treated by head arthroplasty: factors of life prognosis. 477 cases (author's transl)].

477 cases of femoral head arthroplasty for fresh femoral neck fractures were reviewed to study the various factors modifying life prognosis during the first six months (age, associated disorders, type of prothesis, postoperative complications). Certain of these factors were found to affect prognosis unfavorably: bad general health, alcoholism, psychiatric or neoplasic disease, diabetes, and also, to a less degree, senility, neurologic and sensorial disturbances, cardiac deficiency. A rate table makes it possible to make a prognosis on the basis of these different factors.

Age Factors↗